Should Shame Be Used to Treat Sexual Compulsions?

The concept of “sex addiction” has become deeply embedded in our culture — people toss the term around pretty easily, and it’s the subject of TV shows, documentaries, and a profitable cottage industry of treatment centers. The problem is, as Science of Us has noted before, the scientific evidence for sex addiction being similar to alcohol or drug addiction is very, very thin, and it may be the case that people who believe or are told they have sex addiction actually have other stuff going on.

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And yet, it’s undoubtedly the case that many people show up at therapists’ offices worried about sexual behavior that feels compulsive. How do therapists who are skeptical of the idea of sex addiction deal with these patients? That’s the question at the center of an interesting article in SELF by Zahra Barnes.

Barnes does a good job laying out the strong majority view that “sex addiction” shouldn’t be viewed in the same way as other, more scientifically validated forms of addiction, and she also contrasts the way different sorts of therapists deal with sexually compulsive behavior. As she explains, therapists who hew to the majority view often take a “harm reduction” approach to patients who are complaining of compulsive behavior.

“It’s humanistic, meaning it privileges the subjective experience of a person and doesn’t try to apply some external model on what they’re describing, and it’s culturally libertarian, meaning as long as they’re not hurting anyone, you allow people to behave the way that they want and give them the space to do it,” said Michael Aaron, Ph.D., a sex therapist in New York City and author of Modern Sexuality.]

This method can work for people troubled by their sexual urges and those with compulsive sexual behavior. “Rather than trying to change something, we need to acknowledge it and embrace it,” Aaron says. He offers the example of someone who has fantasies of traumatizing children sexually or being sexually violent toward women: “The harm reduction approach asks, can you play out some of these themes with a consenting partner?” The aim is to satisfy these desires with a willing partner instead of suppressing them, which can just make them stronger, he explains.

Therapists who do believe in the addiction model work differently, and where this difference manifests itself most strongly is in their approach to shame. While Aaron and other harm-reduction researchers try to stay away from shaming their patients, which they say can worsen compulsive behaviors, believers in the sex-addiction model see things differently:

“Sex addicts need to feel some shame about what they’re doing, because they are shameless. When people are shameless, they rape and murder and steal and pillage and get into politics,” [says Alexandra Katehakis, clinical director of the Center for Healthy Sex.]. But this is different from shaming someone, she says. “Shaming in an unprincipled way is out of bounds [for a mental health professional],” she explains. That would include saying or even implying that someone is disgusting based on what they’re doing. Rather, she asks questions designed to make someone reflect on what their actions have wrought, like, “What do you think that feels like for your partner?” It’s helpful, not damaging, she explains, because, “It challenges them to see what they’re doing, and it brings them into the reality of their behavior.”

It seems like one of the key philosophical differences here is the question of the extent to which people can control their most primal sexual urges. The therapists who don’t believe in sex addiction appear to view people’s sexual preferences (for lack of a better term given they probably aren’t preferences) in a holistic context — if people are “acting out” sexually in a way that harms others, it could be because of other stuff going on in their lives. You address the behavior by addressing the root causes. The believers, on the other hand, focus more on the urges and finding ways to address the behavior and urges in and of themselves.

These approaches aren’t fully compatible, so it’s no surprise there’s tension between the majority of sex researchers who don’t believe in the addiction model and the minority who do.